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Saline-immersion therapeutic endoscopy (SITE): An evolution of underwater endoscopic lesion resection

Published:September 01, 2017DOI:https://doi.org/10.1016/j.dld.2017.08.035
      Since its first description in 2012 [
      • Binmoeller K.F.
      • Weilert F.
      • Shah J.
      • et al.
      Underwater EMR without submucosal injection for large sessile colorectal polyps (with video).
      ], underwater endoscopic mucosal resection (U-EMR) has become an increasingly recognised technique for resection of mucosal lesions of the gastrointestinal (GI) tract as an alternative to submucosal injection-dependent endoscopic mucosal resection (EMR). In selected cases, U-EMR has been shown to obviate the need for submucosal lifting. This was originally described by Binmoeller et al. [
      • Binmoeller K.F.
      • Weilert F.
      • Shah J.
      • et al.
      Underwater EMR without submucosal injection for large sessile colorectal polyps (with video).
      ] who through their observations at endoscopic ultrasound (EUS), found that mucosal lesions tend to ‘float away’ from the deeper wall-layers of the GI tract, once immersed in liquid. This allows for safe and rapid resection of mucosal lesions, with the technique being particularly useful in challenging anatomic locations such as the duodenum, where the submucosal injectate tends to disperse itself very rapidly [
      • Binmoeller K.F.
      • Shah J.N.
      • Bhat Y.M.
      • et al.
      Underwater EMR of sporadic laterally spreading nonampullary duodenal adenomas (with video).
      ,
      • Miura Y.
      • Shinozaki S.
      • Hayashi Y.
      • et al.
      Duodenal endoscopic submucosal dissection is feasible using the pocket-creation method.
      ]. Within the upper GI tract and small bowel however, U-EMR requires the infusion of several litres of water, raising the risk of the already documented adverse event of water intoxication and its associated potentially serious sequelae [
      • Binmoeller K.F.
      • Shah J.N.
      • Bhat Y.M.
      • et al.
      Underwater EMR of sporadic laterally spreading nonampullary duodenal adenomas (with video).
      ].
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      References

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